BOOK REVIEW
The complexity of the saga is remarkable , and Mr . Borrell weaves together an intricate web of political drama , bench science , clinical science and corporate players . The web of characters is both frustrating in its complexity yet fascinating . Mr . Borrell includes a necessary “ cast of characters ” without which the casual reader may struggle to keep the characters straight . He underscores the collaborative nature of scientific work and , ultimately , the technical and logistical difficulties of developing and disseminating clinically useful products .
In the book trailer , available on YouTube , Mr . Borrell , or at least his publishers , highlight four key researchers : Dr . Jason McClellan of the University of Texas , Dr . Barney Graham and Dr . Kizzmeikia Corbett of the Vaccine Research Center , NIAID , and Dr . Ralph Baric , virologist . While these four barely scratch the surface of the individual story lines , one of the many less emphasized scientists ’ stories stands out , Hungarian immigrant Dr . Katalin Kariko of the University of Pennsylvania . Dr . Kariko ’ s story is a subtext to the initial founding of Moderna , but ultimately her work was imperative for Moderna , and eventually BioNTech , to move forward with their mRNA vaccines .
Moderna ’ s roots started from a breakthrough in a lab in the late aughts at Harvard Medical School under the direction of Dr . Derrick Rossi . Dr . Rossi discovered the ability to use mRNA to turn normal cells into stem cells . Concurrently , Dr . Kariko at Penn was able to modify mRNA to not only keep it stable but also prevent it from being overly immunogenic in cell culture studies . UPenn filed the patent application for the technology but was unable to reach a viable business agreement with Dr . Kariko . Ultimately Dr . Kariko moved on to BioNTech having suffered this one , of many , defeats at Penn , that included a demotion and funding removal . By 2017 , Moderna had been unable to circumvent Dr . Kariko ’ s discovery and was forced to license her patented technology for $ 75 million ( of which Dr . Kariko earned only $ 2 million ). Ultimately her future employer , BioNTech , licensed the technology on the same terms . Dr . Kariko ’ s work , initially under-appreciated and hoarded by the larger academic institutional machine , was the linchpin in mRNA vaccine technology . Her work and her story are but one example of the many discoveries in the mRNA vaccine story . As Mr . Borrell puts it plainly , “ The path from a scientific hunch to a lifesaving product is rarely a linear one .”
As one might expect , realpolitik factors heavily into this story . Dr . Bob Kadlec , the Assistant Secretary for the Office of Preparedness and Response , in one of the more historic events and remarkable chapters of the book , quietly called a meeting in his office for a Manhattan Project-themed brainstorming session . Dr . Kadlec , who had fallen out of favor with the Trump administration , called the meeting quietly and casually , over boxes of pizza and a skeleton crew of staffers . Dr . Kadlec brought in Dr . Peter Marks , an oncologist-cum-FDA-regulator well known for his forward thinking , who suggested producing vaccine while they were still being studied , with funding by the government . Dr . Kadlec knew the path to Trump ’ s approval was through Jared Kushner . He needed a lead man inside the White House and tapped Paul Mango , the HHS deputy chief of staff . This all sounds reasonable until , as fans of the show Veep understand all too well , self-interest and political wrangling interfere in chaotic and often foul-mouthed ways . Cue the angry calls from senators , the reallocation of resources to please other agency leaders , leaked emails to the press , and covert personnel swaps . Ultimately , this complex portion of the story demonstrates the dysfunction within the political system juxtaposed with the dedicated , educated , and remarkably accomplished staff throughout government agencies . Moreover , what is most remarkable is the inside look at the moment of inception for Operation Warp Speed .
Reading The First Shots , it is not surprising that Donald Trump figures into the saga at numerous points . Interestingly , the accounts of conversations and unreported events by Mr . Borrell , leave a mixed view of Mr . Trump , at least regarding the COVID-19 vaccine development . Certainly , Mr . Trump , author of The Art of the Deal , brought a sense of business acumen to the White House , even if not always legitimate and forthright . In announcing Operation Warp Speed , Mr . Trump called it “ big and fast ,” two things in business for which he seemed famously to have a proclivity . Yet , Mr . Trump , during his presidency , also famously offered little support for the scientific truths or methods on which Operation Warp Speed was based . In one discussion regarding Mr . Trump ’ s fetal tissue ban , Dr . Fauci notes , “ It does interfere with some of our vaccine and therapeutic work .” Mr . Trump replied , “ Well get rid of it , then .” At many points in the book , Mr . Trump is equally reactionary and blunt . There is a sense in the text that Mr . Trump ’ s seeming unawareness of scientific methods and processes paradoxically allowed more freedom to the government scientists to move the process along , less constrained by his meddling . While this seems a fortuitous mishap , at numerous other points Mr . Trump seems more interested in meddling for political points , hindering progress .
The First Shots , nothing if not an interesting read , gives a behind the scenes view of what played out in front of our eyes in the news . There is a level of scientific density early in the book that would be well handled by anyone versed in the biologic sciences . Yet , as the story unfolds , there is a density of details , storylines , and layers that only a seasoned bureaucrat could easily assimilate . Regardless , the story of Operation Warp Speed is fascinating . Ultimately , Mr . Borrell paints a picture of many principled Americans working for the greater good of the country and the world , navigating , or possibly overcoming , political dysfunction . It is the principled characters whom Mr . Borrell spotlights most vividly , leaving the reader with hope amidst an ongoing worldwide pandemic .
Dr . Kolter is a practicing internist with Baptist Health .
June 2022 19